Pertti Keskivaara

Job strain and early atherosclerosis: The cardiovascular risk in young Finns study

Objective: The purpose of this study was to determine whether job strain and social support are associated with early atherosclerosis measured by carotid intima-media thickness (IMT) in young adults. Methods: The subjects were 478 men and 542 women (mean age 32.3) who were participating in the ongoing prospective Cardiovascular Risk in Young Finns study. Job strain was defined as a joint effect of job demands and job control. Early atherosclerosis was determined with IMT ultrasound. The associations between job strain, social support, and IMT were evaluated using multiple linear regressions. Results: In men, job strain was associated with increased IMT after adjustment for age. This association was not attenuated by additional adjustment for established risk factors of coronary heart disease. In women, job strain was not associated with IMT. No 3-way interaction of job demand, job control, and social support on IMT was found. Conclusion: These findings suggest that job strain may be related to atherosclerosis already in its early nonsymptomatic stages in men. BMI = body mass index; CHD = coronary heart disease; CRYF = Cardiovascular Risk in Young Finns; HDL = high-density lipoprotein; IMT = intima-media thickness; LDL = low-density lipoprotein; OSQ = Occupational Stress Questionnaire; PAI = physical activity index; SES = socioeconomic status.

Cardiovascular diseases, health status, brain imaging findings and neuropsychological functioning in neurologically healthy elderly individuals

The aim of our study was to evaluate the relationship between health-related factors, brain imaging findings and cognitive functioning. We examined 113 neurologically healthy subjects from 55 to 85 years of age. Health-related variables included a clinical health evaluation, cardiovascular diseases, and other systemic diseases. The presence of white matter changes and cerebral and peripheral atrophy were obtained with magnetic resonance imaging. Neuropsychological tests measuring verbal memory, visual memory, intellectual and language functions, visuoconstructional functions, flexibility, and speed and attention were administered. Results showed that overall health status was not related to cognition. Subjects, who had both arterial hypertension and white matter changes had difficulties in flexibility. Cardiac failure and white matter changes were related to impairment in visuoconstructional functions, flexibility and attention. Significant speed and attention deficits were observed in subjects with cardiac failure and central atrophy. In conclusion, this study verifies the relationship between hypertension, white matter changes and cognitive functions. We found also specific patterns in relation with cardiac failure, brain imaging findings and cognitive functioning, the most vulnerable domains were visuoconstructional functions, flexibility and attention.

Maternal Child-Rearing Attitudes and Role Satisfaction and Children's Temperament as Antecedents of Adolescent Depressive Tendencies: Follow-up Study of 6- to 15-Year-Olds

Development of depressive tendencies was assessed over a 9-year period in a random sample of 389 Finnish children. Predictors of maternal role satisfaction and hostile child-rearing attitudes, assessed when the children were ages 6 and 9 years, respectively, and a temperament predictor of perceived child difficultness, assessed when the children were age 6 years, were measured using questionnaires designed for this study. Depressive tendencies were assessed by a self-report at age 15 (modification of Becks Depression Inventory). Using structural equation modeling, we tested a hypothesized model comprising direct as well as mediated effects between the childhood predictor variables and adolescent depressive tendencies. The results indicated support for a similar mediational model in girls and boys. Low maternal role satisfaction and maternal perceptions of child difficultness, measured when children were age 6 years, predicted hostile maternal child-rearing attitudes measured when children were age 9 years, which in turn had a significant direct effect on depressive tendencies among these children during adolescence. The only other direct effect was found solely in girls: Low maternal role satisfaction predicted adolescent depressive tendencies. These results underline the close interplay of child temperament and mothering factors in the development of depressive tendencies in girls and boys.

Predictors of distress in cancer patients and their partners: the role of optimism in the sense of coherence construct.

Aim: The aim of this study was to clarify the associations between sense of coherence (SOC), dispositional optimism and distress (i.e. anxiety and depression) in cancer patients and their partners. Methods: The associations between SOC, dispositional optimism (Life Orientation Test-Revised, LOT-R), depression (Beck Depression Inventory-14, BDI-14) and anxiety (Endler Multidimensional Anxiety Scales, EMAS-State) were studied in 147 cancer couples. The data were collected with self-report questionnaires at the time of diagnosis (2 months) and after 6 months. Path analysis was used to analyse the predictors of follow-up distress and crossover effects in the longitudinal data. Results: Optimistic patients and patients with strong SOC as well as their partners reported fewer symptoms of depression and anxiety than less optimistic subjects and subjects with weaker SOC. Optimism partially explained the effect of SOC on distress and SOC seemed to be an independent factor in predicting distress. Patient and partner distress at baseline and at 8-month follow-up correlated positively. In addition, high partner optimism at baseline seemed to predict low patient anxiety at follow-up. Conclusions: The beneficial effects of SOC seem to include also other elements beyond optimism. In clinical practice, enhancing optimistic expectations of the future and promoting SOC could be expected to reduce distress in cancer patients and their partners.

Type A factors as predictors of changes in the metabolic syndrome precursors in adolescents and young adults--a 3-year follow-up study.

The predictive associations of Type A factors with changes in some essential parameters of the cluster of disorders known as metabolic syndrome (Syndrome X) were studied during a 3-year follow-up period in 1,147 randomly selected healthy adolescents and young adults. Type A behavior was measured with the Hunter Wolf A-B Rating Scale. Physiological parameters studied were serum insulin, high-density and low-density lipoprotein cholesterol, triglycerides (TG), systolic and diastolic blood pressure, body-mass index (BMI), subscapular skinfold thickness (SSF), and centrality index. Among the Type A factors in boys and men, high baseline Aggression predicted an increase in the individual parameters of metabolic syndrome (i.e., insulin, TG, SSF, and BMI) as well as a global aggravation of the cluster of metabolic parameters. In girls and women, increases in Eagerness-Energy and Responsibility across the 3 years of follow-up predicted an increase in serum insulin and a decrease in SSF, respectively.

Anger is associated with subclinical atherosclerosis in low SES but not in higher SES men and women. The Cardiovascular Risk in Young Finns Study

We investigated the associations of anger and cynicism with carotid artery intima-media thickness (IMT) and whether these associations were moderated by childhood or adulthood socioeconomic status (SES). The participants were 647 men and 893 women derived from the population-based Cardiovascular Risk in Young Finns Study. Childhood SES was measured in 1980 when the participants were aged 3–18. In 2001, adulthood SES, anger, cynicism, and IMT were measured. There were no associations between anger or cynicism and IMT in the entire population, but anger was associated with thicker IMT in participants who had experienced low SES in childhood. This association persisted after adjustment for a host of cardiovascular risk factors. It is concluded that the ill health-effects of psychological factors such as anger may be more pronounced in individuals who have been exposed to adverse socioeconomic circumstances early in life.

The synchronization of electrodermal activity and heart rate and its relationship to energetic arousal: a time series approach

We examined the synchronization between indices of autonomic nervous system (ANS) function and its relation to multiple measures of arousal in 37 middle-aged men. Electrodermal activity (EDA), heart rate (HR), and subjective and behavioral arousal were measured during administration of the Rorschach test. Prevailing mood and depression were also measured. The relationship between phasic EDA and HR activity was assessed by constructing within-subjects time series models. The results showed that phasic EDA and HR accelerations were synchronized, while there was no association between tonic EDA and HR in between-subjects analysis. In addition, EDA-HR synchronization was positively associated with verbal activity, variability of arousal experience, and activation mood, and negatively associated with depression. It is suggested that within-subjects analysis of physiological time series data can further our understanding of the individual differences in ANS function and on the correlates of effector organ synchronization.

Depressive symptoms and serum lipid fractions in middle-aged men: physiologic and health behavior links.

Objective: To investigate alternative hypothetical models that could clarify the relationship between depressive symptoms and serum cholesterol fractions, i.e., high-density lipoprotein (HDL) and low-density lipoprotein (LDL). It was hypothesized that the impact of the depressive symptoms on cholesterol fractions is mediated through health behavior and body mass index, and at the same time there would be a direct link from depression to cholesterol. Methods: The study sample consisted of 893 middle-age men who participated in a trial aimed at preventing the metabolic syndrome, Type 2 diabetes and cardiovascular diseases. Serum cholesterol was measured by the enzymatic method. Participants completed self-report questionnaires assessing health behavior and depressive symptoms. Results: Depressive symptoms consistently correlated statistically significantly with adverse lifestyle factors and, as hypothesized, positively with HDL. Path analyses supported the parallel existence of two main pathways: from depression through adverse health behavior to unfavorable cholesterol fraction balance, and a direct physiological link indicative of beneficial effect of depression on cholesterol levels. Conclusions: It is concluded that, among a sample of men, depressive symptoms are linked to cholesterol fractions through two different pathways. An adverse relationship of depression with serum lipids HDL-LDL balance is partly mediated through harmful health behaviors. At the same time, the results indicate a direct, physiological link between depressive symptoms and cholesterol that has a beneficial influence on the HDL-LDL balance. AIC = Akaike information criterion; BDI = Beck Depression Inventory; BMI = body mass index; BP = blood pressure; CAD = coronary artery disease; CFI = comparative fit index; CVD = cardiovascular diseases; EM = expectation-maximization; GFI = goodness-of-fit index; HDL = high-density lipoprotein; HMSP = Helsinki Metabolic Syndrome Prevention Trial; LDL = low-density lipoprotein; NFI = normed fit index; PGFI = parsimony goodness of fit index; RMSEA = root mean square error of approximation.

Confidence in work-related goals and feelings of exhaustion during a therapeutic intervention for burnout: A time-series approach

This study investigated recursive relations between confidence in achieving work-related goals and work exhaustion among employees who participated in an intervention to reduce their burnout. Thirty-six employees of age 33-59 years suffering from severe burnout (28 females and 8 males) filled in burnout and well-being measures before and after a 10-month therapeutic intervention. They also filled in weekly measures of confidence in work-related goals (progress and capability) and work exhaustion throughout the intervention, as well as 4 weeks before and 4 weeks afterwards. Intra-individual variation was modelled using dynamic factor analyses. The results showed that, for most participants, confidence in work-related goals and work exhaustion during a given week could be predicted from those of the preceding week. Moreover, high self-esteem predicted low weekly stability in goal confidence, whereas high burnout contributed to high weekly stability in work exhaustion. The intra-individual stabilities in goal confidence and exhaustion also predicted which of the participants benefited from the intervention in terms of increasing well-being and decreasing work-related stress.

Difficult temperament predicts self-esteem in adolescence

A six‐year longitudinal study investigated the impact of maternal hostile child‐rearing attitudes, role dissatisfaction, and maternal perceptions of adolescent temperamental difficultness on self‐esteem in late adolescence, after controlling for the initial self‐esteem measured in early adolescence. Adolescents (n = 313), derived from the Cardiovascular Risk in Young Finns study, rated their self‐esteem at the study entry at age 12, and six years later at age 18. Maternal reports of child‐rearing attitudes, of role satisfaction, and of the temperament of the adolescent were obtained at the study entry and three years later. Mothers perceptions of adolescents temperament as difficult at ages 12 and 15 predicted adolescents self‐reported self‐esteem in late adolescence, whereas earlier self‐esteem did not predict later perceptions of temperament or parenting. We found no evidence that maternal perceptions of parenting indirectly, or after controlling for the initial level, predicted adolescents self‐reported self‐esteem. Copyright